Life-saving surgery allows college-bound teen to finish basketball career on his own terms

By Meredith Whittemore

Garett Pineault recognized that his senior year of high school basketball would be his last one. But a rare condition put that special season in jeopardy.

After nearly a decade of playing, Garett is headed to Texas A&M in the fall and collegiate sports weren’t in his plans, barring the intramural or recreational leagues available.  It’s why Garett’s senior season as point guard at Deer Park High School was so important to him, and partially why he brushed off the initial symptoms. He didn’t want to miss a single game.

“I practice every day, so when my arm started feeling sore, I thought it was from all the practice time I was putting in,” Garett said.

Garett didn’t know he had an extra right upper rib, called a cervical rib. Every time he raised his arm and took a shot, the cervical rib would compress blood vessels, slowly creating a blood clot and narrowing the main vein returning blood from the arm to his heart and lungs, a condition called thoracic outlet syndrome, or TOS. 

“There are three main types of TOS depending on what structure is being compressed. Each type causes a different set of symptoms,” said Kristofer Charlton-Ouw, MD, a vascular surgeon affiliated with Memorial Hermann-Texas Medical Center. “In Garett’s case, the cervical rib compressing his right subclavian vein and causing the clot is also known as effort thrombosis or Paget-Schroetter Syndrome. The vein clot prevents blood from flowing out of the arm and leads to swelling and pain.”

Garett’s father saw that his arm was swollen, and they went to a nearby freestanding emergency room. Physicians there suspected a case of flesh-eating bacteria, and said he needed to be treated in the Texas Medical Center. His father took him to Memorial Hermann-TMC.

“Although there was pain, swelling and some redness, this did not look like an infection to us. A venous ultrasound study showed the clot in the main vein in the arm. A chest X-ray showed the presence of the cervical rib.  We treated Garett with clot dissolving medicine and anticoagulants, commonly called ‘blood thinners,’” said Dr. Charlton-Ouw, who is also an associate professor of vascular surgery at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

Garett was shocked to learn he had an extra rib.

“When they first told me I had a massive blood clot, I wanted to know why. I’m young, I’ve never done drugs or drunk alcohol, so I really wanted to know what caused it. Then when they told me I had an extra rib, I was surprised. I’ve always had a broad chest, so it’s not something I ever noticed or thought about,” he said.

After the clot cleared, Dr. Charlton-Ouw removed the cervical rib and the anterior scalene muscle in Garett’s neck to reduce the risk of another clot forming in the future. Garett returned to the basketball court a few weeks after surgery.

“The nurses and staff were really amazing, checking in on me all the time. Dr. Charlton-Ouw explained everything really well and I felt really comfortable in his care,” he said.

Garett is sad his time playing competitive basketball has ended, but happy he got to say goodbye to the game he loves in his own way.

“I only had to miss a few games, so I was glad that I had an option that meant I would recover and get back on the court,” Garett said. “Plus, I’ll be heading off to college in the fall and I’m glad that I won’t have to be on medication or have any physical restrictions.”

The Memorial Hermann Heart & Vascular Institute offers comprehensive vascular care by taking a multidisciplinary approach to the detection and treatment of cardiac and vascular diseases. Learn more about the full spectrum of conditions treated at Memorial Hermann, or schedule and appointment with a vascular surgeon near you.


  1. Garrett is a great scholar athlete with a caring and fun loving spirit! What a great story to share – promoting a very positive young man and enlightening people about this medical issue. You just never know who it might help.
    For Garrett, you would never have known he had an extra rib up there – but I have thought he had a great big heart – for his studies, his family, and the game of basketball!
    Gig’em Garrett!

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